Identifying predictors of high sodium excretion in patients with heart failure: A mixed effect analysis of longitudinal data

Abstract

Background A low-sodium diet is a core component of heart failure self-care but patients have difficulty following the diet. Aim The aim of this study was to identify predictors of higher than recommended sodium excretion among patients with heart failure. Methods The World Health Organization Five Dimensions of Adherence model was used to guide analysis of existing data collected from a prospective, longitudinal study of 280 community-dwelling adults with previously or currently symptomatic heart failure. Sodium excretion was measured objectively using 24-hour urine sodium measured at three time points over six months. A mixed effect logistic model identified predictors of higher than recommended sodium excretion. Results The adjusted odds of higher sodium excretion were 2.90, (95% confidence interval (CI): 1.15–4.25, p<0.001) for patients who were obese; 2.80 (95% CI: 1.33–5.89, p=0.007) for patients with diabetes; and 2.22 (95% CI: 1.09–4.53, p=0.028) for patients who were cognitively intact. Conclusion Three factors were associated with excess sodium excretion and two factors, obesity and diabetes, are modifiable by changing dietary food patterns.

Using Growth Mixture Modeling to Identify Classes of Sodium Adherence in Adults With Heart Failure

“…The methodology for collecting and measuring dietary sodium intake has been reported elsewhere 15 and is summarized here. Dietary sodium intake was estimated using three 24-hour urine sodium levels measured at enrollment, and at three and six months after enrollment.…”

“…Deterministic methods, including mixed effects modeling have previously been used to identify patient-level factors associated with high sodium intake using an a priori determined cutoff of adherence. 15 This study builds on that analysis by applying a growth mixture modeling methodology to identify the “most likely” trajectory membership and quantify uncertainty in trajectory membership over time.…”

“…The secondary aim was to build on a previous mixed effects analysis 15 and examine patient-level determinants of observed trajectories of urine sodium.…”

The Situation-Specific Theory of Heart Failure Self-Care

“…70 Dietary sodium adherence is influenced by the quantity of food intake and access to diverse food sources. 71 2. Clusters of physical and emotional symptoms influence self-care in unique and important ways.…”

Racial Differences in Clinical Treatment and Self‐Care Behaviors of Adults With Chronic Heart Failure

“…37 Objective measures of self‐care included 24‐hour urine samples, which were obtained to allow calculation of urinary sodium excretion to indicate salt‐restricted diet adherence. 38 Medication adherence was monitored for 6 months using the medication event monitoring system (MEMS; MVW Switzerland Ltd, Sion, Switzerland). 39 All data were collected between 2007 and 2009.…”